This video discusses a case involving partial thickness colonic/rectal endometriosis with severe pain with defecation. The video demonstrates dissection technique for bowel mobilization and resection of the lesion, as well as generalized intraperitoneal and retroperitoneal dissection techniques.
For clinical consultation with Dr Fogelson in Portland, OR, contact Pearl Women’s Center at 503-771-1883
Today I sat in the infection control committee at Grady Memorial hospital and listened to two sales pitches for products meant to decrease surgical site infection. I am a tough sell at these meetings. Some might even say that I am the asshole in the room. But really the issue is that I say what everyone else is thinking but are too polite to say.
The first pitch was from Ethicon, who was marketing their antimicrobial impregnated suture. The presentation shows convincing evidence that the suture, placed in a petri dish surrounded by bacteria, does in fact inhibit bacterial growth. There were many claims made that it also decreased the rates of wound infections in comparison to using typical suture. When I questioned what data there were to suggest this, I was told that the data was all in my handouts.
I looked down at my handouts and found no data whatsoever. I found a bibliography of about thirty articles that investigated the product. I pointed out that there is no data, just a list of articles. I was reassured that these data support everything that they are saying.
At this point I was kind of pissed.
As I rolled into my office this morning I noticed that my white coat was looking a little dingy. Fortunately, my AA ordered me a bunch of coats so I always have some hanging up, fresh from the cleaners. Usually she has to tell me to switch them. Occasionally I notice myself. Either way, I don’t tend to walk around with a coat that isn’t at least mostly white.
But it wasn’t always that way. As a resident, I had a habit of finding out just how brown a white coat can be. It was hard to tell for me, as the change was very gradual. But a few years into a residency, I could stand next to someone with a truly white coat and the difference was, well, ghastly. But now it is different, and while I have to give my AA credit, in truth the credit goes to my third year REI attending, Dr John Schnorr.
I started my REI rotation early in my third year. Effectively, this meant that the two white coats I had been given at the beginning of my internship were somewhere between yellow and poo. I walked into the Taj Mahal office, as REI offices tend to be, and presented myself to Dr Schnorr. He gave me a funny look that I didn’t quite pick up on. He then proceeded to go over all the rules and responsibilities for the rotation, as would be typical for the orientation.
We had a great first day. At the end of it, I could tell he was a little uncomfortable about something. He hesitated, then he came out with it.
“Do you get your coats laundered?”
This was a very polite Southern way of saying “Your coat looks like shit”
As if I had to say it.
But then he said the greatest thing.
“Just throw your coats in our laundry bin…. our people will launder them for you.”
So I did, and was forever changed. When I got that first laundered coat, all bleach white and starched, I never looked back.
So residents – take your coat to the cleaners from time to time… its only seven bucks, but it looks like a million.
Academic OB/GYN, and I, Nicholas Fogelson, are honored to have so many great twitter followers. Over time it has come to pass that there are two populations of followers – 1) people that are interested in the Academic OB/GYN blog, podcast, and related educational materials and 2) people that are interested in the unrelated musings of myself. At present, @academicobgyn is a combination of those two things.
So things are getting separated:
If you want to hear about things related to the blog, the podcast, and other things of medical interest, continue to follow @academicobgyn.
If you want to hear from me on a more personal level, follow @nickfogelson.
Or follow both.
The recent hulabaloo with KV Pharmaceuticals and Makena continues, with multiple news and blog articles popping up every day. Senator Brown is trying to get the FTC to do an anti-trust investigation. The FDA is interested, but sadly they have no purview in pricing of drugs. Many newscasts have done pieces on the issue, the vast majority leaning towards condemning KV for their pricing of Makena. One aspect of the issue has been March of Dimes’ initial support of KV getting the FDA approval for the product.
The March of Dimes has been a positive organization for decades, and generally does a lot of good work. This one really blew up in their face. MOD was a major player in pushing the FDA to give orphan drug status to 17-OHP, paving the way for KV to bring Makena to market. Jennifer Howse, PhD, president of MOD, has stated that the MOD had no idea of the planned pricing structure, and I believe her. Nonetheless, the MOD has suffered a great deal of bad press and in some cases decreased donations because of their association with KV and Makena.
Today the March of Dimes delivered a letter to KV Pharmaceuticals, saying a lot of the things that we have been saying. It must have been a tough letter to write, given the amount of financial support KV has given to MOD, and the potential for that to end. While I don’t think the letter was perfect, I think it was pretty good for a major organization that has a lot of difference issues to keep in balance. Here it is:
Follow us at @academicobgyn for little thoughts about articles, issues in academics, research thoughts, and whatever else comes to mind.